Loading...
HomeMy WebLinkAbout03-01-12~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 11-0736 BUREAU OF INDIVIDUAL TAXES / '1 Po BOX 280601 ~~ ~ AN D HARRISBURG PA iTlzs-o6o1 Penn ACN 11151055 DEPARTMENT ~ ,~~ ~~ P~~f [affAXPAYER RESPONSE DATE os-o1:~2011 REY-1563 E% AFP (RS-11) - zos2Ma~ - ~ P~ is 25 Vl.Gf7li ~F (~I'HAN'S fAURr ~lME~RLANf~ C0 , .~q TIMOTHY A WEBSTER WA'XTfAW~ - 9 9.5~ Ceved~le pr i ~ e GG-~1 ~~o~e Nc ae~~ TYPE OF ACCOUNT EST. OF MARJORIE B WEBSTER ^ SAVINGS SSN 209.-16-.1.427.. .CHECKING DATE OF DEATH `06-29-2011 TRUST COUNTY, CUMBERLAND...... ~ CERTIF. REMIT PAYM~NT;AND FORMS Tb: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 P NC BANK NA provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a point owner/beneficiary of this account. If yoU ere the spouse of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to_the deceased by checking Box C in PART 1 below and writing "spouse"_in PART 2. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5004221479 Date 04-24-2010 To ensure Prover crvdit to the account, two Established copies of this notice must accompany Account Balance 4 083 00 Payment to the Register of Wills. Make chock " " , . $ payable to Register of Wills. Apent . Percent Taxable X 50.000 Amount Subject to Tax ~` 2041.50 NOTE: If tax payments are made within three months of the decedent's date of death, Tax Rate ~( .045 deduct a 5 percent discount on the tax due. Any inheritance tax due will becou delinquent Potential Tax Due ~` 91 .87 nine months after the date of death. P RT -TAXPAYER RESPONSE A 1 A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or return this notice to the Reeister of Wills and C 0 N E ~ an official assessment will be issued by the PA Department of Revenue. BLOCK B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return 0 NL Y filed by the estate revresentative. C. ~ The above informs ion is incorrect and/or debts and deductions were Paid. Complete PART 2~ and/or PART 3^ below. PART If indicating a different tax rate, please state relationship to decedent: TAX RE TURN - CALCULATION OF TAX 0 JOINT/TRUST ACCOUNTS .-ass - ~- ,..~- ~.~,,s._~.,_..- __ 4 - --- ---------- 3_..... ,. ~.....~. --v~f~__~ _..___ _ 2. , Account Balance -- 2 $ -. O$ .dv 3. Percent Taxable 3 X .j~.0 4. Amount Subject to Tax 4 $ ~~~~ ~ • S~ 5. Debts and Deductions 5 - ~.1R3.9 ~ 6. Amount Taxable 6 $ ~ 7. Tax Rate 7 X 8. Tax Due 8 $ p ~ PART DEBTS AND DEDUCTIONS CLAIMED Undsr Psnaltiss of .perjury, I declare that the facts I reported a ove are true, correct and lets t the best of my knowledgs and belief. ,t ~ pp //j/~ C lam'! ) .~ 6tJ¢(dW-(~ WORK C~ ~3~f1 SA ~~ ,iota ~XPAY I6NATURE TELEPHONE NUMBER DA E DATE PAID PAYEE DESCRIPTION AMOUNT PAID Part 3 Debts and Deductions claimed Date Paid Payee Description Amount Paid 7/5/2011 Register of Wills payment for short form $96.50 7/6/2011 Carlisle Regional hospital hospital bill $31.40 7/6/2011 Century Link telephone bill $41.51- 7/6/2011 Wilma Jackson Organist for funeral $75.00 7/6/2011 ~ Carlisle HMA Physician Mang. Doctor Bill $119.82 7/6/2011 Chapelle Pointe at Carlisle Rent $224.57 7/30/2011 Hoffman Roth Funeral Home Funeral expense $462.32 8/1/2011 Kinetic Imaging xrays $10.78 9/3/2011 Carlisle Region Medical center Hospital bill $1132.00 Total $2193.90 ..; ~. .. w .~ ~'; 4 Q) S C {~1 ~ ~. .~.~- z 3 v' _ ~- ~~ ~ ©`"~- ~= ~ ~ ~~ ~ N -~, .. .... v ~, ~~ ~ ~"' .v+ ~. ~. V ~ . /`\ ~( "~I- `~` u} ,~f':.. ~' ~ ~ ~ 5 ,` may) ~~ O ~~ ~ ~ ~ ti , ~ ~ ~J __--=- _ _~-. ~_-